¡¡ By Will Boggs, MD
NEW YORK (Reuters Health) - X-ray screening is associated with a halving of gastric cancer mortality in a community in Costa Rica, according to a report in the October 2nd issue of the British Journal of Cancer.
"Mortality from gastric cancer can be substantially reduced with a good, well-designed screening intervention," Dr. Luis Rosero-Bixby from Universidad de Costa Rica, San Jose, told Reuters Health. But this does not come cheap and it is not easy to do.
Dr. Rosero-Bixby and Dr. R. Sierra evaluated the impact of a two-wave mass-screening program for gastric cancer carried out in Costa Rica from 1996 to 2000.
X-ray detected gastric pathologies meriting endoscopy in 34% of participants in the first wave of the study and 20% of participants in the second wave, resulting ultimately in the diagnosis of 59 gastric cancers in the first wave and 28 in the second wave.
Most cancers (55% in the first wave, 80% in the second wave) were at an early stage, the report indicates.
Sensitivity of X-ray screening for detecting gastric cancer was around 90% overall, but the positive predictive value was only 3%.
The mortality rate during the 2 to 7 years after screening was considerably lower than the rates in the control groups, the investigators say, ranging from 41% to 52% of the control rates.
Five-year survival among screened patients found to have gastric cancer was 95% for early cases and 77% for late cancer stage at diagnosis, significantly higher than in the control groups.
Based on a cost of $1,000 per examination, the researchers estimate the pilot program to be around $300,000 per saved life.
"In any scenario, the costs of the screening program seem far too high in a country like Costa Rica where yearly health expenditures are in the order of $300 per capita," the authors write.
"The public health system in Costa Rica currently limits X-ray screening to the highest risk area in the country," Dr. Rosero-Bixby explained. "A danger with this approach may be that individuals who feel themselves healthy will not go for the screening." For a successful program, much parallel education will be needed to motivate individuals to attend screenings.
Br J Cancer 2007;97:837-843.
|
